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What Scientists Know About the Unusual Hepatitis Cases in Children – The New York Times

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Officials are exploring the possibility that a common adenovirus might be responsible for the unexplained cases, which remain rare.

At least 16 countries and 10 U.S. states have either identified or are investigating reports of unusual hepatitis cases in otherwise healthy children.

The cases remain extremely rare, with about 200 children affected worldwide, according to a report issued last week by the European Centre for Disease Prevention and Control.

But even these small clusters are unusual. In Britain, where most of the cases have been reported, two pediatric liver units have already had at least as many admissions for acute, unexplained hepatitis in 2022 as they typically have in an entire year, according to a briefing from the U.K. Health Security Agency.

Most children should recover fully, experts said, but some cases have been severe. In nearly 10 percent of reported cases, children have required liver transplants, according to the World Health Organization. There has been at least one death, the W.H.O. said.

The cause remains unknown, but scientists are exploring the possibility that an adenovirus may be responsible. Adenoviruses are common, but they are not usually associated with hepatitis in healthy children. And with many nations only now beginning to look for cases in earnest, the scope of the problem remains unknown.

“It’s still early days,” said Dr. Richard Malley, an infectious disease specialist at Boston Children’s Hospital. “It’s hard to predict whether this will become more common or if, in fact, it will just be a blip in our 2022 infectious-disease story.”

Here’s what scientists know so far.

Hepatitis is an inflammation of the liver and can have a wide range of causes. Viral infections can cause the condition; the viruses known as hepatitis A, B, C, D and E are all known triggers.

Heavy drinking, as well as certain medications and toxic substances, can also cause hepatitis. In autoimmune hepatitis, the body’s own immune system attacks the liver.

Sudden and severe hepatitis in previously healthy children is uncommon, which is why the new clusters of cases have prompted concern.

In early April, Britain became the first country to notify the W.H.O. of a cluster of unexplained hepatitis cases in children. The cases were unusual because they occurred over a short period of time in otherwise healthy children, and because clinicians quickly ruled out any of the common hepatitis viruses as the cause. They did not identify any patterns in travel, diet, chemical exposures or other risk factors that might explain the outbreak, according to the U.K. Health Security Agency’s briefing.

Since then, Austria, Belgium, Denmark, France, Germany, Ireland, Israel, Italy, Japan, the Netherlands, Norway, Poland, Romania, Spain and the United States have reported similar cases, the E.C.D.C. said.

In the United States, Alabama recorded nine cases between October and February. Three of the children developed liver failure, and two required liver transplants, the Centers for Disease Control and Prevention noted in a recent report. All of the children either recovered or are recovering, the agency noted.

“The two that received the transplant are actually doing quite well,” said Dr. Henry Shiau, a pediatric transplant hepatologist at the University of Alabama at Birmingham and the Children’s of Alabama hospital.

The cases prompted the C.D.C. to issue a nationwide alert, asking health care providers to keep an eye out for similar cases.

Illinois and Wisconsin have since announced potential cases. North Carolina, Delaware, Minnesota, California, New York, Georgia and Louisiana have also identified, or are investigating, possible cases, state officials told The New York Times.

In many of the cases, children developed gastrointestinal symptoms, including vomiting, diarrhea and abdominal pain, followed by a yellowing of the skin or eyes, known as jaundice. They also had abnormally high levels of liver enzymes, a sign of liver inflammation or damage.

Gastrointestinal symptoms are common in children and should not, in isolation, be cause for alarm, Dr. Shiau said. But a yellowing of the skin or eyes are more telltale signs of liver problems, he said.

“The likelihood of your child developing hepatitis is extremely low,” Dr. Meera Chand, the director of clinical and emerging infections at the U.K. Health Security Agency, said in a statement. “However, we continue to remind parents to be alert to the signs of hepatitis — particularly jaundice, which is easiest to spot as a yellow tinge in the whites of the eyes — and contact your doctor if you are concerned.”

“That’s the million-dollar question,” Dr. Shiau said. “I want to be up front about this: We don’t know.”

But one leading hypothesis is that an adenovirus — one of a group of common viruses that often cause cold-like symptoms — is responsible. Of the 169 cases included in a recent W.H.O. report, at least 74 had an adenovirus infection, the organization said. Eighteen of those children were infected with what is known as adenovirus type 41, which typically causes gastrointestinal and respiratory symptoms.

Adenovirus infections have been on the rise in Britain, where most of the hepatitis cases have been reported, the W.H.O. said.

But the explanation is not a perfect fit. Not all of the children have tested positive for an adenovirus, and while the viruses can cause liver inflammation, that symptom is most common in people who are immunocompromised. “It is not a common cause of liver failure in kids,” said Dr. Aaron Milstone, a pediatric infectious diseases specialist at Johns Hopkins Children’s Center.

It is possible that a new adenovirus strain has emerged or that adenovirus infections are occurring in conjunction with some other risk factor — such as a toxic exposure or an infection with another pathogen — causing these unusually severe outcomes, the U.K. Health Security Agency said.

Or the adenovirus infections could be a red herring. Because the viruses are so common among children, it is difficult to determine whether they are the cause of these hepatitis cases or whether many of the children have been infected incidentally. “Somebody could be infected with adenovirus and then develop hepatitis based on something else,” Dr. Malley said. “For proof of causality you really need a lot of data, which we just don’t have.”

Probably not directly, experts said. Of the 169 patients identified by the W.H.O., 20 tested positive for the coronavirus. That is not surprising, given how widely the virus has been spreading in recent months, scientists said.

And there is no evidence that the hepatitis is linked to the Covid-19 vaccines; the “vast majority” of the children in question had not been vaccinated, the W.H.O. said.

Still, a coronavirus connection cannot be entirely ruled out, experts cautioned, and the hepatitis cases may be linked to the pandemic in less direct ways. For example, the public health measures implemented over the past two years may have left fewer children exposed to common adenoviruses. That, in turn, might have made them more susceptible now, according to one of the U.K. Health Security Agency’s working hypotheses.

But that, too, is speculative.

“At this point,” Dr. Shiau said, “we still don’t know what’s going on.”

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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September 13, 2024

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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September 11, 2024

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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September 10, 2024

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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